Incidence and Predictors of Myocardial Infarction Among HIV-Infected Patients

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DESCRIPTION (provided by candidate): In an era when HIV-infected patients are living longer on antiretroviral therapy, understanding the complications of long-standing HIV infection and its treatment is critical to the care of this group. Recent studies indicate increased rates of cardiovascular risk factors among HIV patients, and several studies have evaluated coronary heart disease rates among HIV patients. No study to date, however, has examined the issue prospectively comparing HIV patients to demographically matched non-HIV controls. The primary aim of the proposed study is to examine the incidence and predictors of myocardial infarction among an HIV cohort compared to a non-HIV cohort using a prospective observational study design. Specific aims include: Aim 1: To investigate the baseline characteristics and cardiovascular risk profile of HIV and non-HIV cohorts derived from a large health care system-based data registry. Aim 2: To determine the incidence of acute myocardial infarction over a four-year period in HIV and non-HIV cohorts derived from a large health care system-based data registry in a prospective case cohort study. Aim 3: To analyze the predictors of acute myocardial infarction in a multivariate regression model and to validate a risk prediction tool in HIV and non-HIV cohorts. To achieve these goals, a unique data source will be employed that allows investigators to generate cohorts and track outcomes for large numbers of patients for whom comprehensive demographic and clinical data are reliably captured. The results of this study will have implications for the optimal management of HIV patients with respect to cardiovascular disease. These insights will be especially important for groups in whom cardiac risk is thought to be low in the absence of HIV infection, such as young women. The public health applications of this research will include the development of cardiovascular risk prediction, risk modification, and treatment strategies tailored to HIV patients. Such strategies will likely take on increasing importance in resource-limited settings as antiretroviral therapy becomes more widely available. The intersection of HIV and cardiovascular disease is an emerging and significant field. The strength of the candidate's commitment and background, a team of mentors with a wide range of expertise, and extensive institutional resources will provide a uniquely well-suited environment to promote career development in clinical investigation and improve the well being of HIV patients.